病灶切除辅以皮质癎灶热灼术治疗顽固性癫癎

目的　观察病灶切除辅以皮质灶横纤维热灼术治疗顽固性癫的临床效果。方法　将病灶切除辅以皮质灶热灼术 2 91例病人和单纯病灶切除术 78例病人的疗效进行分析比较。结果　病灶切除辅以皮质灶热灼组效果优于单纯病灶切除组 ,两者的临床效果存在显著性差异 (P <0 0 5 ) ;同时 ,病灶切除辅以皮质灶热灼术组无永久性的术后并发症。结论　病灶切除辅以皮质灶热灼术是治疗顽固性癫安全有效的方法 ,长期疗效有待进一步观察。     

病灶切除辅助周围痫灶皮质横纤维热灼治疗继发性癫痫

目的：观察病灶切除辅助周围痫灶皮质横纤维热灼治疗继发性癫痫的临床效果。方法：比较71例病灶切除加热灼的患和78例单纯病灶切除患的疗效。结果：病灶切除辅助热灼组效果优于单纯病灶切除组，两存在显差异（P＜0．05）。病灶切除加热灼治疗无术后并发症。结论：病灶切除辅助周围病灶皮质热灼是治疗继发性癫痫的安全有效的方法。     

神经导航引导海马病灶切除联合皮质热灼治疗顽固性颞叶内侧癫痫

目的探讨神经导航引导、皮质电极监测下对海马病灶进行致痫灶切除,辅助以皮质痫灶横纤维热灼术治疗顽固性颞叶内侧癫痫的临床价值。方法通过对16例海马病灶的顽固性癫痫的病人,术前进行24小时脑电图描记定位致痫灶,手术前进行磁共振扫描,数据输人神经导航系统,手术当天进行导航注册配准．术中进行颞叶皮质电极描记,并在导航棒引导下找寻海马病灶,完整切除并辅以皮质热灼治疗致痫灶。结果术后0．5～3年内随访,按Engel癫痫疗效分级：发作完全消失11例(68．8％),明显改善4例(25％),改善1例(6．2％)。结论神经导航有助于海马病灶的准确找寻与切除,在皮质电极监测下,辅助皮质热灼是治疗顽固性颞叶内侧癫痫的一种有效、安全的方法。     

病灶切除辅助周围 灶皮质横纤维热灼治疗继发性癫

目的观察病灶切除加周围灶皮质横纤维热灼治疗继发性癫的临床效果。方法对71例病灶切除加热灼的病人和78例单纯病灶切除病人的疗效进行对比分析。结果病灶切除辅助热灼组效果优于单纯病灶切除组,两者存在显著性差异。病灶切除加热灼无术后并发症。结论病灶切除辅助周围灶皮质热灼是治疗继发性癫安全有效的方法,长期疗效有待于进一步观察。     

病灶切除辅助周围癎灶皮质横纤维热灼治疗继发性癫癎

目的 观察病灶切除加周围癎灶皮质横纤维热灼治疗继发性癫癎的临床效果。方法 对71例病灶切除加热灼的病人和78例单纯病灶切除病人的疗效进行对比分析。结果 病灶切除辅助热灼组效果优于单纯病灶切除组，两存在显性差异。病灶切除加热灼无术后并发症。结论 病灶切除辅助周围癎灶皮质热灼是治疗继发性癫癎安全有效的方法，长期疗效有待于进一步观察。     

痫灶切除辅助脑皮层横行热灼治疗功能区顽固性癫痫

目的为了验证脑表浅层热灼治疗功能区癫痫的可行性及临床效果,我们首次应用功能区痫灶切除后,并辅助功能区皮层痫灶双极电凝热灼治疗.方法难治性癫痫124例,颞叶癫痫75例(包括原发52例;继发23例),非颞叶癫痫48例及1例功能性大脑半球切除者,以上病例均行病灶和痫灶切除.不能切除的功能区皮层痫灶行双极电凝脑表多处横行热灼.双极电凝输出功率为4μ,持续时间为1-2秒,脑表热灼间距为5mm.痫灶切除前后和功能区痫灶热灼前后均行皮层脑电监测.对术后早期和远期的表现进行了观察.结果功能区皮层热灼无SAH出现,脑软膜上血运不受热灼影响.病理证实浅表层(Ⅰ-Ⅱ)有不同程度的热凝损伤.其下Ⅲ层部分神经元变性,固缩,胶质增生不明显.而深部(Ⅳ-Ⅵ)神经元未受损.对64例术后病人随访6个月-3年,癫痫发作消失病人为51例;癫痫发作减少大于75%的病人为10例,癫痫发作减少大于50%的病人为4例,总有效率为97.5%.结论位于功能区不能切除的痫灶,辅以脑表热灼的治疗方式,可大大提高手术疗效.热灼治疗,它的优点在于安全、易行及治疗效果好,故可在临床推广应用.     

难治性癫痫的外科治疗(附36例临床分析)

目的探讨难治性癫痫的致病灶定位和术式选择。方法回顾分析36例难治性癫痫患者的临床资料,术前均行视频脑电监测(VEEG)和CT/MR检查,结合临床症状定位致痫灶。采用颞前叶及海马、杏仁核切除+广泛致痫皮层低功率电凝热灼25例;额叶癫痫+周围皮层低功率皮层热灼术5例,病灶及周围皮层切除+低功率皮层热灼术4例,行单侧病灶切除+胼胝体前部切开+致痫皮层低功率电凝热灼2例。结果经6个月至3年的随访,满意29例,显著改善5例,良好2例。结论部分性发作的癫痫患者,最可靠的治疗方法是致痫灶的切除,但对于全面性发作的病人,其致痫区往往比较广泛而无法切除,联合皮层热灼术可以减少发作频率、减轻发作程度和改变发作形式,提高治疗效果。准确定位致病灶,选择恰当的手术方式是外科治疗难治性癫痫取得良好效果的关键。     

手术方法治疗顽固性癫痫

目的 对顽固性癫痫病人联合采用几种手术方法，对其临床疗效进行评价，以探讨不同类型顽固性癫痫的最佳治疗方案。方法 手术治疗顽固性癫痫5l例。术前均行头皮脑电视频连续监测，及MRI、SPECT检查。行单纯局部致癫痫病灶切除术7例，加行皮质软膜下横纤维切断术3例，加行皮质热灼术12例，加行皮质热灼术及胼胝体切开术5例；前颞叶切除术 皮质热灼术17例，立体定向核团毁损术6例，迷走神经刺激术l例。结果 无手术死亡及术后并发症，随访3～24个月，于术总有效率90．2％，优良率70．6％。结论 多种手术联合治疗顽同性癫痫病人安全、有效。     

痫灶切除方式对顽固性癫痫手术疗效的影响

目的：探讨影响手术治疗顽固性癫痫疗效的因素。研究痫灶切除方式、病灶存在与否与疗效的关系。方法：对1992年以来术后随访3件以上的51例顽固性癫痫进行回顾性分析。采取Ridit分析，比较痫灶完全切除组（20例）与痫灶不完全切除组（31例）、占位组（28例）与非占位组（23例）的疗效。结果：全组显效率达88．23％。1．痫灶完全切除组的疗效较痫灶不完全切除组好（P＜0．01）；2．占位组与非占位组疗效无差别（P＞0．05）。结论：痫灶切除程度对顽固性癫痫手术疗效有重要影响，有无占位性病灶对疗效影响不大，进一步说明了病灶与痫灶是二个不同的概念。把痫灶切除与否作为影响疗效的主要因素更具合理性。     

痫灶切除辅助性脑皮层横行纤维热灼治疗功能区癫痫的临床研究

目的：采用低功率热灼的方法，毁损脑皮层的横行纤维，治疗功能区顽固性癫痫，观察该方法在临床的实用性和有效性。方法：124例难治性癫痫患者，手术切除非功能区致痫灶后，辅助热灼功能区的致痫灶或癫痫样放电。非功能区致痫灶切除后，功能区致痫灶热灼前后均行皮层脑电图监测。病理观察热损伤的深度和范围。结果：热灼后肉眼下见：皮层呈红白相间的条纹状改变，与多软膜下横纤维切断术（MST）类似。显微结构见：热损伤仅在脑浅皮层（Ⅰ-Ⅱ）。随访108例术后病例1-5年，癫痫发作消失的占75.9%，总有效率91.7%。术后9例病人出现一过性的功能障碍，但均在一周左右恢复。结论：非功能区致痫灶切除辅助功能区致痫灶热灼，其疗效肯定，方法安全可靠，易在临床推广。     

病灶切除与热灼联合术在难治性癫痫治疗中的应用

目的 研究病灶切除与热灼联合手术方法治疗继发性、难治性癫痫的临床效果。方法 对291例继发性、难治性癫痫患采取病灶切除与热灼联合手术的治疗方法，并随访观察此种联合手术方法对难治性癫痫的控制效果：结果 采用病灶切除与热灼联合手术后，291例患中，有211例(72．5％)发作消失，有50例(17．2％)发作减少50％以上，对癫痫总的有效控制率为89．7％，随访1．5～4．0年，平均23个月，211例发作消失的患中有83例(39．3％)已停服抗癫痫药；同时，病灶切除与热灼联合术无永久性的术后并发症：结论 病灶切除与热灼联合术治疗继发性、难治性癫痫，安全并且治疗效果令人满意。     

幕上脑海绵状血管瘤并癫痫的手术策略(附57例临床分析)

目的探讨伴有癫痫病史的幕上脑海绵状血管瘤(CA)的手术策略。方法回顾性分析57例伴有癫痫病史的幕上脑海绵状血管瘤患者的资料,依据癫痫发作情况将其分为顽固组(41例)和偶发(或初发)组(16例)。顽固组内行单纯病变切除者15例,行病变切除及致痫灶扩展切除者26例。分别分析其病灶部位、临床表现、切除范围与术后随访结果。结果57例患者均行显微手术治疗,40例部位深在,均运用导航指引术中定位。本组无远期神经功能障碍,术后癫痫控制EngleⅠ级45例(81.8%),EngleⅡ级4例(7.3%),EngleⅢ级4例(7.3%),EngleⅣ级2例(3.6%)。结论①幕上脑海绵状血管瘤伴发癫痫的患者应尽早行手术治疗。②对于初发或偶发癫痫患者,手术切除病变及周围含铁血黄素沉积带即可获得满意的癫痫控制;对于顽固性癫痫患者,在前者基础上加行致痫皮层切除或脑叶切除将获得更理想的效果。③脑磁图检查结合EEG对术前癫痫灶定位有较大帮助。     

难治性癫痫的致痫灶定位及手术治疗研究

目的评价难治性癫痫的致痫灶定位方法和皮层电极监测下致痫灶切除,加行多处软脑膜下横纤维切断术(MST)治疗癫痫的疗效。方法对47例难治性癫痫病人的致痫灶,采用CT MRI EEG 单光子发射计算机体层摄影(SPECT) 皮层脑电脑(ECoG)联合检测定位。对检出的阳性病灶在皮层电极监测显微镜下行致痫灶切除,切除后监测仍有癫痫波者加行MST;致痫灶位于重要功能区者单行MST。结果致痫灶阳性检出率86%。皮层电极检测显微镜下致痫灶切除加MST,术后91%的病人癫痫发作停止,半年后约15%的病人复发,但症状较术前减轻,持续时间较术前短。结论CT MRI EEG SPECT ECoG联合检测,对手术定位具有较高价值。皮层电极监测下致痫灶切除术及MST创伤轻微、效果比较可靠、治愈率高、并发症少、复发率低。病灶及致痫灶的不完全切除和形成皮层软化及疤痕,可能是导致癫痫复发的重要原因。     

A comparative study of lesionectomy versus corticectomy in patients with temporal lobe lesional epilepsy

We performed a retrospective study comparing surgical outcome of anterior temporal lobectomy (n = 20) and stereotactic lesionectomy (n = 14) in 34 consecutive patients with intractable partial epilepsy evaluated at this institution between June 1986 and June 1992. All patients had medically refractory partial seizures and a neuroimaging-identified temporal lobe foreign-tissue lesion. Patients underwent a pre- and postoperative comprehensive evaluation. In all patients, postoperative neuroimaging studies indicated complete lesion resection. Seventy-one percent of lesionectomy patients and 90% of lobectomy patients, respectively, experienced a worthwhile reduction in seizure tendency. Forty-three percent of lesionectomy patients and 85% of lobectomy patients, respectively, were seizure-free postoperatively. Mean duration of follow-up was 51 months (range, 21–83 months). Morbidity occurred in three patients who underwent corticectomy: complete homonymous hemianopsia (1) and dysphasia (2). No significant morbidity was associated with lesionectomy. Results of this study have altered the surgical strategy at this institution for patients with temporal lobe lesional epilepsy and have proved useful in counseling patients regarding neurologic outcome.     

脑功能区难治性癫痫的手术治疗

目的探讨开颅手术对功能区难治性癫痫的疗效。方法84例脑功能区难治性癫痫患者中,采用局部癫痫灶切除 多处软膜下横纤维切断术者29例,癫痫病灶切除 多处软膜下横纤维切断 前颞叶切除33例,癫痫病灶切除 多处软膜下横纤维切断 胼胝体前1/3切开22例。记录术后早期和9￣30个月临床观察及随访结果。结果术后早期16例患者出现一侧肢体肌力减弱,23例患者术后2￣3d出现失语,经治疗均在5￣10d内恢复。出院后随访9￣30个月,完全无发作65例,发作次数减少50%以上11例,发作减少50%以下6例,2例癫痫发作与术前相同。术前有14例言语功能障碍,17例有一侧肌力下降,术后均有不同程度的改善和恢复。结论术后疗效表明局部癫痫灶切除 多处软膜下横纤维切断术和癫痫病灶切除 多处软膜下横纤维切断 前颞叶切除的手术疗效优于癫痫病灶切除 多处软膜下横纤维切断 胼胝体前1/3切开手术方式的疗效。     

Intraoperative electrocorticography‐guided microsurgical management for patients with onset of supratentorial neoplasms manifesting as epilepsy: a review of 65 cases

Aim. We reviewed the surgical procedures guided by intraoperative electrocorticography and outcome of 65 patients with onset of supratentorial neoplasms manifesting as epilepsy. Method. Clinical data were obtained for 65 patients with supratentorial neoplasms who received surgery, with the aid of intraoperative electrocorticography to screen epileptogenic foci before and after removal of neoplasms, and depth electrodes when needed. According to electrocorticography findings, appropriate surgical procedures were performed to treat the epileptogenic foci. In the control group, 72 patients received simple lesionectomy. Postoperative seizure outcomes were documented and analysed retrospectively. Results. In the case group, 33 patients received lesionectomy only, while the other 32 patients underwent intraoperative electrocorticography‐guided tailored epilepsy surgery. In total, 57 patients (87.7%) in the case group and 38 patients (52.8%) in the control group were seizure‐free (Engel Class I). Comparing outcomes of patients with temporal lesions between the two groups, 80.0% patients (12/15) in the case group and 20.0% (3/15) in the control group were seizure‐free. Furthermore, comparing the seizure outcomes of patients who finally underwent tailored epilepsy surgery and simple lesionectomy (33 after electrocorticography and 72 without electrocorticography), intraoperative electrocorticography‐guided tailored epilepsy surgery demonstrated superiority over lesionectomy (Engel Class I; 87.5% vs. 63.8%, respectively). Conclusions. Electrocorticography plays an important role in the localisation of epileptogenic foci and evaluation of the effects of microsurgical procedures intraoperatively. Isolated lesionectomy is not usually sufficient for better postoperative seizure outcome. In addition, for patients with temporal tumours, especially in the non‐dominant hemisphere, a more aggressive strategy, such as an anterior temporal lobectomy, is recommended.     

Surgical Outcome in Patients with Epilepsy with Occult Vascular Malformations Treated with Lesionectomy

Summary: Purpose: This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure.
Methods: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection.
Results: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system.
Conclusions: Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.     

Long-Term Follow-Up of Stereotactic Lesionectomy in Partial Epilepsy: Predictive Factors and Electroencephalographic Results

We performed an extended follow-up study assessing the efficacy of stereotactic lesionectomy in 23 patients with foreign-tissue lesions and intractable partial epilepsy. Sixteen lesions involved functional or eloquent cortex as determined by anatomic localization. By definition, the surgical objective in these patients was excision of the lesion, and not the surrounding cerebral cortex. The mean duration of follow-up was 48.5 months (range 26-69 months). Seventeen patients (74%) had a significant reduction in seizures (greater than or equal to 90%) after lesionectomy. Thirteen patients (56%) had a class I operative outcome (seizure-free, single seizure episode, or auras only). Five of these patients were successfully discontinued from antiepileptic drug (AED) therapy. Patients with temporal lobe lesions were statistically less likely to be rendered seizure-free (p less than 0.05). Age at operation, duration of epilepsy, and underlying pathology were not significant predictors of seizure outcome. The anatomic distribution of extracranial EEG recorded epileptiform activity did not appear to be an important determinant of outcome. The absence of interictal epileptiform activity in the 3-month postoperative EEG correlated with a significant reduction in seizures. Long-term follow-up indicates that lesionectomy may be effective in select patients with medically refractory partial seizure disorders.